against both UVB and UVA radiation—so-called broad-spectrum sunscreens.
You should always use broad-spectrum sunscreen when trying to prevent sunburn. Look for sunscreens that clearly state they protect against both UVA and UVB, because discrepancies still exist in the market. Be aware, too, that no sunscreen can fully protect you.
With all this in mind, it is important to repeat that melanoma usually occurs in parts of the body that are not exposed to the sun and is seen in people who do not spend much time in the sun, two factors that indicate that sun exposure may not be a risk factor for this serious disease.
return home, and it also gives the cancer cell a road map to do so. This is why melanoma can be so deadly. Its power to turn Slug back on gives melanoma a tremendous advantage in spreading throughout the body.
Skin Type, Cancer Risk, and Self-Exams
Because melanin pigment protects skin cells against the damaging effects of the sun, certain people have higher rates of skin cancer than others. People with fairer skin (less pigmented and less protected) have a higher rate of skin cancer than people with darker skin (more pigmented and more protected). Scientists have categorized skin into six different types based on melanin content.
People with type 1 skin have the highest risk of skin cancer and people with type 6 skin the lowest risk. If you have type 1 or type 2 skin and were exposed to excessive amounts of sun as a child, adolescent, or adult—including several severe sunburns—you are in the highest risk group for skin cancer and should
get screened. Some people never get tan, principally those who are very fair skinned or red haired and freckled; they have type 1 skin. The reason people with type 1 skin don’t tan is that the melanocytes in their skin are unable to produce protective melanin pigment. Because their skin is unprotected against the sun’s radiation, these people are highly susceptible to sun damage, including sunburn, and are therefore at the highest risk for skin cancer.
One of the characteristics of skin cancer is that, unlike all other cancers, it is visible. If everyone were vigilant about detecting skin cancer in its early stages through self-exams, the mortality rate for nonmelanoma skin cancer would go down to virtually zero. We know how to catch skin cancer in its early stages, which is the key to reducing its severity. So the key to early detection and treatment of skin cancer is very much in your hands. There’s no need for panic or overreaction, but you need to be on the lookout and know what to look for.
Just as women should do regular breast self-exams, each person should periodically check his or her skin for early signs of skin cancer. How often you do this depends on your risk factors. If you or a close relative has a history of skin cancer, or if other risk factors apply to you—such as if you have fair skin, burn easily, and had a lot of sun exposure as a child—examine your skin once a month. Otherwise, once every six months is probably sufficient. Checking yourself every day is counterproductive because you may not notice subtle changes that could be signs of skin cancer.
A red flag for skin cancer is a change in your skin’s appearance, such as a new growth or a sore that doesn’t heal. Look for these warning signs that you might have a nonmelanoma skin cancer:
• a lump that is small, smooth, shiny, and “waxy” looking
• a lump that is firm and red
• a lump that bleeds or develops a crusty surface
• a flat, red area that is rough, dry, itchy, or scaly
• a scarlike growth that gradually gets larger
If you see any of these changes on your skin, consult your personal physician immediately to determine their cause.
What about signs of melanoma? This very rare but dangerous form of skin cancer generally begins as an irregular-shaped, flat blemish colored a mottled light brown to black. Melanomas are usually at least one quarter inch across. The blemish may crust on the surface and bleed. Melanomas usually appear on the upper back, torso, belly button, backs of the legs, lower legs, head, or neck. They
also can be detected in the genital areas. Seek medical attention for a mole that changes size, shape, or color; a new mole; or a mole that looks odd or unsightly or begins to grow. Remember that pain is not an indicator of a skin cancer. Until it progresses to quite an advanced stage, a skin cancer won’t hurt or sting. This fact reinforces the need to see a doctor as soon as you have any legitimate suspicion.
If you examine your skin regularly, you will become familiar with what on your body is normal. If you find anything suspicious during the course of your examination, see your doctor right away. Remember, the earlier skin cancer is found, the more straightforward the treatment program is and the greater the chance for successful resolution. If a doctor thinks a growth looks suspicious, he or she will order a biopsy. In this simple office procedure, the patient is given a local anesthetic and all or some of the suspect tissue is removed and examined under a microscope.
If skin cancer is diagnosed, there are various options for treatment. The doctor’s goal will be to totally remove or destroy the cancer while leaving as small a scar as possible. Types of surgery include cryosurgery (destruction by freezing with liquid nitrogen), laser surgery (using a laser beam to cut away or vaporize growths), and curettage and electrodesiccation (using a spoonlike blade to scoop out the growth, then destroying surrounding tissue with an electric needle). Occasionally, other treatments, such as radiation therapy or chemotherapy, may be used alone or in combination.
Precise treatment and follow-up for both nonmelanoma skin cancer and
melanoma depends on a variety of factors, including the cancer’s location and size; the risk of scarring; and the person’s age, health, and medical history. All of this is too complex to comprehensively cover in this book. An excellent resource for information on skin-cancer treatment is the National Cancer Institute. You can access its Web site at www.cancer.gov/CancerInformation/CancerType/skin.